Complex pulmonary aspergilloma treated by cavernostomy / Tratamento do aspergiloma pulmonar complexo por cavernostomia

Objective: To evaluate the effectiveness of cavernostomy in patients with complex fungal balls. Methods: We analyzed the medical records of patients undergoing cavernostomy between January 2005 and May 2013, evaluating: age, gender, preoperative signs and symptoms, predisposing disease, preoperative tests, location of the aspergilloma, etiologic agent, cavernostomy indication, postoperative outcome. Results: Ten patients were male. The mean age was 42.9 years (34-56). The most frequent symptom was repeated pulmonary bleeding. Cavernostomy was proposed for patients at high risk for lung resection. It was performed in 17 patients and all of them had pulmonary tuberculosis sequelae, with cavitations. The indication in all cases was hemoptysis and elimination of phlegm. The cavernostomies were performed in a single surgical procedure. In all 17 patients the cavity was left open after the withdrawal of the mycetoma. In all patients hemoptysis ceased immediately. Operative mortality was 9.5% (1). Conclusion: cavernostomy is an effective treatment alternative in patients at high risk. It may be useful in some patients with complex aspergilloma, irrespective of lung function or bilateral disease. It is technically easy, has low-risk, saves parenchyma, and may be performed in a single operative time. .

Objetivo: avaliar a efetividade da cavernostomia nos pacientes com bola fúngica complexa. Métodos: foram analisados os prontuários de pacientes submetidos à cavernostomia entre janeiro de 2005 e maio de 2013. Foram avaliados: idade, sexo, sinais e sintomas pré-operatórios, doença predisponente, exames pré-operatórios, localização do aspergiloma, agente etiológico, indicação da cavernostomia, evolução pós-operatória. Resultados: dez pacientes eram do sexo masculino. A média de idade foi 42,9 anos (34-56). O sintoma mais frequente foi o sangramento pulmonar repetido. A cavernostomia foi proposta para os pacientes com risco elevado para ressecção pulmonar, foi realizada em 17 pacientes e todos eles apresentavam sequelas de tuberculose pulmonar com lesões cavitárias. A indicação em todos os casos foi hemoptise e eliminação de catarro. As cavernostomias foram realizadas em tempo cirúrgico único. Nos 17 pacientes a caverna foi deixada aberta após a retirada do micetoma. Em todos os pacientes a hemoptise cessou imediatamente. A mortalidade operatória foi 1 (9.5%). Conclusão: a cavernostomia é uma alternativa de tratamento efetivo em pacientes com risco elevado. Pode ser útil em alguns pacientes com aspergiloma complexo, independentemente da função pulmonar ou doença bilateral. É tecnicamente fácil, de baixo risco, poupa parênquima, e realizada em tempo operatório único. .

Complex pulmonary aspergilloma treated by cavernostomy.

OBJECTIVE: To evaluate the effectiveness of cavernostomy in patients with complex fungal balls. METHODS: We analyzed the medical records of patients undergoing cavernostomy between January 2005 and May 2013, evaluating: age, gender, preoperative signs and symptoms, predisposing disease, preoperative tests, location of the aspergilloma, etiologic agent, cavernostomy indication, postoperative outcome. RESULTS: Ten patients were male. The mean age was 42.9 years (34-56). The most frequent symptom was repeated pulmonary bleeding. Cavernostomy was proposed for patients at high risk for lung resection. It was performed in 17 patients and all of them had pulmonary tuberculosis sequelae, with cavitations. The indication in all cases was hemoptysis and elimination of phlegm. The cavernostomies were performed in a single surgical procedure. In all 17 patients the cavity was left open after the withdrawal of the mycetoma. In all patients hemoptysis ceased immediately. Operative mortality was 9.5% (1). CONCLUSION: cavernostomy is an effective treatment alternative in patients at high risk. It may be useful in some patients with complex aspergilloma, irrespective of lung function or bilateral disease. It is technically easy, has low-risk, saves parenchyma, and may be performed in a single operative time.

[Usefulness of chest CT in the diagnosis of pulmonary sequestration]. / A utilidade da TC de tórax no diagnóstico do sequestro pulmonar.

Pulmonary sequestration is a rare congenital anomaly, characterized by nonfunctional embryonic pulmonary tissue. Pulmonary sequestration accounts for 0.15-6.40% of all congenital pulmonary malformations. This anomaly, which is classified as intralobar or extralobar, involves the lung parenchyma and its vascularization. We report the case of a 56-year-old male presenting with hemoptysis. A chest X-ray showed an area of opacity behind the cardiac silhouette in the base of the left hemithorax. Chest CT scans with intravenous contrast revealed pulmonary sequestration. The patient underwent surgery, in which the anomalous tissue was successful resected. The postoperative evolution was favorable, and the patient was discharged to outpatient treatment.

A utilidade da TC de tórax no diagnóstico do sequestro pulmonar / Usefulness of chest CT in the diagnosis of pulmonary sequestration

O sequestro pulmonar é uma rara anomalia congênita, caracterizada por tecido pulmonar embrionário não funcionante, perfazendo 0,15-6,40 por cento de todas as malformações pulmonares congênitas. Essa anomalia envolve o parênquima e a vascularização pulmonar, sendo classificado como intralobar ou extralobar. Neste relato, descrevemos o caso de um paciente de 56 anos com hemoptise e imagem hipotransparente retrocardíaca em base de hemitórax esquerdo na radiografia de tórax. Após a realização de TC com contraste endovenoso, foi evidenciada a presença de sequestro pulmonar. O paciente foi submetido à cirurgia para a retirada do tecido anômalo, que foi realizada com sucesso. Apresentou boa evolução pós-operatória e recebeu alta com acompanhamento ambulatorial.

Pulmonary sequestration is a rare congenital anomaly, characterized by nonfunctional embryonic pulmonary tissue. Pulmonary sequestration accounts for 0.15-6.40 percent of all congenital pulmonary malformations. This anomaly, which is classified as intralobar or extralobar, involves the lung parenchyma and its vascularization. We report the case of a 56-year-old male presenting with hemoptysis. A chest X-ray showed an area of opacity behind the cardiac silhouette in the base of the left hemithorax. Chest CT scans with intravenous contrast revealed pulmonary sequestration. The patient underwent surgery, in which the anomalous tissue was successful resected. The postoperative evolution was favorable, and the patient was discharged to outpatient treatment.